Medical Imaging Unit - General - Guideline Section

Part B – Health Facility Briefing & Design 160 Medical Imaging Unit - General

International Health Facility Guidelines Version 5 December 2016

International

Health Facility Guidelines © TAHPI

Part B: Version 5 Dec 2016

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Table of Contents

160 Medcial Imaging Unit – General ............................................................................................... 3

1 Introduction ............................................................................................................................................... 3 Description .................................................................................................................................................. 3

2 Functional and Planning Considerations ............................................................................................... 3 Operational Models ..................................................................................................................................... 3 Planning Models .......................................................................................................................................... 3 Functional Areas ......................................................................................................................................... 4 Functional Relationships ............................................................................................................................. 8

3 Design ...................................................................................................................................................... 11 Construction Standards ............................................................................................................................. 11 Environmental Considerations .................................................................................................................. 11 Space Standards and Components .......................................................................................................... 12 Safety and Security ................................................................................................................................... 13 Finishes ..................................................................................................................................................... 13 Fixtures, Fittings and Equipment ............................................................................................................... 13 Building Service Requirements ................................................................................................................. 13 Infection Control ........................................................................................................................................ 14

4 Components of the Unit .......................................................................................................................... 15 Standard Components .............................................................................................................................. 15 Non Standard Components ....................................................................................................................... 15

5 Schedule of Accommodation – Medical Imaging Unit - General ........................................................ 16 Medical Imaging Unit – General ................................................................................................................ 16

6 Future Trends .......................................................................................................................................... 22

7 Further Reading ....................................................................................................................................... 22

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160 Medical Imaging Unit – General

1 Introduction

Description

The general Medical Imaging Unit is a discrete facility of the hospital which provides radiology and diagnostic investigations. Depending on the level of service and the clinical service plan, the unit may also provide diagnostic screening (fluoroscopy), ultrasound, mammography, computed tomography (CT), magnetic resonance imaging (MRI) or interventional radiographic procedures such as angiography. The general Medical Imaging Unit may be co-located with or incorporate other specialties including Nuclear Medicine, PET and Oncology - Radiotherapy Units in a fully integrated imaging suite. 2 Functional and Planning Considerations

Operational Models

Hours of Operation

The Medical Imaging Unit will normally operate 24 hours per day, seven days per week. Smaller units may operate on a long day basis with an after-hours emergency service, depending on the hospital’s operational policy.

Models of Service Delivery

The Medical Imaging Unit may be provided as:

As a single unit managed and operated by the hospital

A main facility with satellite units located for ease of patient access under the management of the hospital

A privately owned and operated facility, providing a service to all hospital units and sharing support areas with the hospital. As this is a popular model of service delivery, this option needs to be identified early in the planning process in order to allow the associated space requirements, design issues and cost implications to be addressed

An off-site service; smaller hospitals that cannot justify a full Medical Imaging Unit, may consider access to off-site specialist services; this option needs to be identified during the planning phase, in particular, the location of the off-site services.

The general Medical Imaging Unit may be arranged in a variety of models, depending on the hospital’s clinical services plan that may include:

A comprehensive unit located adjacent to the Emergency Unit and with good functional links to Outpatient Units

A unit integrated with Nuclear Medicine & Radiotherapy

A centralised Unit with satellite imaging services for Emergency Unit, outpatient ultrasound, intraoperative imaging, cardiac angiography (Catheter Laboratories) or other interventional imaging specialties.

Planning Models

The planning of a Medical Imaging Unit will be dependent on the imaging specialties to be included and the operational model adopted.

Location

The location of Medical Imaging is important for easy access by emergency patients, ambulant patients and inpatients. The Medical Imaging Unit should ideally be located on the ground floor with direct access to the Emergency Unit (EU) unless satellite imaging is provided within the EU.


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The relative location of Outpatients Unit should be considered in the planning stage due to the volume of outpatient referrals to the Unit. Refer to Functional Relationships in this section for ideal internal relationships to be considered during the planning stages.

Functional Areas

The Medical Imaging Unit may consist of the following Functional Areas depending on the Clinical service plan of the Unit and the services to be provided:

Entry/ Reception areas incorporating: - Reception desk for patient registration and to act as an access control point - Waiting for a range of occupants including children, families, elderly, and patients with

limited mobility - Consult room for patient assessment and review - Amenities – toilets, vending areas for refreshments - Offices and workstations for Unit management and clerical functions

Imaging and screening areas: - General and digital X-ray rooms

General and digital X-ray rooms Screening (Fluoroscopy rooms) Patient Change cubicles associated with each x-ray room

- Access to patient amenities - Support areas including patient bed bays, handwashing bays, storage for linen, supplies

Dental/ Oral imaging: - OPG Room - Sub waiting facilities

CT Scanning including: - CT Scanning rooms

Control, reporting and computer module equipment rooms Patient Change cubicles associated with each scanning room

- Sub waiting areas - Access to patient amenities - Support Rooms including bays for linen, handwashing, utility room and store rooms

Ultrasound including specialty rooms such as paediatric and interventional

Mammography rooms including interventional rooms

Angiography/ Digital Subtraction Angiography (DSA) with: - Scanning, control, reporting and computer module equipment rooms - Anaesthetic induction rooms - Patient Change cubicles associated with each scanning room - Holding and recovery bed bays - Support areas including linen bays, utilities,

MRI suite with - Scanning, control, reporting and computer module equipment rooms - Patient Change cubicles associated with each scanning room - Sub-waiting area - Support facilities including bays for linen, handwashing, utility rooms and store rooms - Access to patient toilets

Shared Support Areas including - Cleaner’s room/s - Communications room - Dark Room, this room may not be required if a filmless digital imaging system is

implemented - Digital Processing areas - Film processing areas - daylight as required - Store rooms for film, files, stationery, general consumables

Staff Office and Reporting areas: - Offices for Unit Director, Senior Radiologist/s, Senior Radiographer/s, Nurse Manager/

Supervisor


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- Workstations for clerical staff, PACS technical staff, general imaging staff - Staff Amenities including Staff Room, Change Rooms with Showers, Toilets, Lockers - Meeting Rooms.

Entry/ Reception/ Waiting Areas

The Reception is the receiving hub of the unit where patients are first registered and should therefore ensure the security of the entire department through access control. Patient registration may include a booking and queuing system for effective management of patient bookings. Waiting areas may be divided into separate female/ family areas to meet cultural requirements and will require convenient access to public amenities. The Waiting areas should be designed for compliance with accessibility standards and be provided with a range of seating options for occupants of varying mobility including bariatric patients. Waiting areas should include provisions for prams and a play area for children. Bed waiting areas should be separated from the ambulatory patient waiting areas for patient privacy.

X-ray, Screening and Scanning Areas

General X-ray and Fluoroscopy (Screening) General X-ray rooms may be clustered with Fluoroscopy Screening rooms in order to share support facilities. The General X-ray room equipment will generally include an upright bucky stand for chest films. OPG and Mammography imaging equipment may be included in a General X-ray room where imaging equipment is not fully utilised. Additional equipment will require a slightly larger room. If satellite imaging rooms are not provided in the Emergency Unit (EU), a minimum of one General X-ray room must be sized and located with rapid access for transfer of patients from Emergency Unit. Fluoroscopic radiographic imaging procedures involve administration of contrast media to the patient and the timed use of a fluoroscopic imaging system along with sequential repositioning of the patient. The Fluoroscopy room will require a preparation room for barium mixtures and an adjacent toilet/ shower that may be accessed from inside the room and from the external corridor. Fluoroscopy Screening may be combined with an Angiography room, due to the decreasing incidence of barium usage. The room should include services for anaesthesia.

Orthopantomography (OPG) OPG is an orbital X-ray of the upper and lower jaws, displaying teeth on a single film, used in dental, trauma, and facio-maxillary services. This equipment may be incorporated into a General X-ray room, a separate bay or within the Dental Unit.

Computerised Tomography (CT Scanning) CT Scanning uses X-ray and computer technology to create detailed digital images, both two and three dimensional. CT scanning equipment consists of a rotating ring inside a gantry with a sliding table for the patient. Multiple images are taken in slices which are combined using computer technology. The CT Scanning room will have an associated Control Room and computer equipment room. Refer to the Standard Component for CT Scanning for detailed room requirements. A Control Room may service 2 rooms. The room should include services for general anaesthesia and be sized for interventional procedures. A bed/ trolley bay adjacent to each room is required for staff observation of waiting patients.

Angiography/ Digital Subtraction Angiography (DSA). Angiography involves x-ray imaging the inside of blood vessels using an injection of contrast media. Simple angiography procedures such as peripheral studies can be done on fluoroscopy equipment.


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Digital Subtraction Angiography (DSA) refers to a process where contrast media is injected into a vessel in the area being examined. Images are taken of the blood vessels before and after injection with contrast media. The pre-contrast images are subtracted from the post contrast images by computer resulting in clear blood vessel images. Procedures using this type of imaging include angiography, angioplasty, arterial and venous stents, biliary and renal artery imaging. DSA procedures are becoming less popular in favour of CT scanning due to the ability to produce 3D images of vessels using a less invasive procedure.

Endoscopic Retrograde Choleopancreatography (ERCP) ERCP is a procedure that uses endoscopy and fluoroscopy to diagnose and treat conditions of the biliary and pancreatic ductal systems including removal of gall stones, insertion of stents for strictures, repair of leaks and removal of cancer. These are gastrointestinal endoscopy procedures that may be performed in the Medical Imaging Unit or in an Endoscopy Unit.

Mammography Mammography imaging or breast screening may be included for diagnostic purposes according to the hospital’s operational policies. Mammography rooms should provide sufficient area for interventional procedures such as needle biopsy that may require bed access and prone positioning. Mammography should be located adjacent to an Ultrasound Room for fine needle biopsies. Change Rooms should be accessible directly from the Mammography room and an Interview Room will be required in close proximity.

Magnetic Resonance Imaging (MRI) MRI scanning is a non-invasive procedure using large magnets combined with radio waves and a computer to receive signals from atoms in body tissue creating detailed cross section images of organs and vessels. MRI does not use ionising radiation. The location of the MRI is important to restrict access, protect the magnetic field from interference and reduce the extent of electro-magnetic shielding required. Specifically the MRI should be located:

with good external access for installing and servicing the equipment; this may be achieved through an accessible side panel

distant to any moving metal objects that may cause interference such as lifts, passing cars, construction equipment.

The MRI should not be located below a helipad or next to a sub-station Facilities required in the MRI suite include:

Patient change rooms with lockers for personal property (personal property particularly items with a metallic content must not be taken into the MRI room including watches, credit cards and keys)

An Interview Room for patient discussion

Storage for equipment (non-metallic) Planning and design should consider the following:

Structural assessment is required to ensure the floor/ slab will accommodate the weight of the MRI

The MRI unit and the associated magnetic field must be fully contained within the room, according to the equipment selection and specifications, that will require liaison with the equipment supplier

The MRI room will require magnetic shielding and radiofrequency shielding, to be determined in conjunction with the equipment supplier, according to the machine specifications

Access control is required to the MRI suite, the MRI room and the support areas within the suite to ensure authorised entry. Recommended exclusion zones are divided into four stages including: - Zone 1: Entrance which may be shared with general radiology


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- Zone 2: Reception, Waiting which may be shared, patient screening, toilet and change room

- Zone 3: MRI waiting, patient preparation, recovery, control and equipment rooms - Zone 4: MRI Scanning room

Equipment and fittings in the room including emergency equipment such as fire extinguishers and gas bottles need to be constructed of non-ferrous material.

MRI rooms are to comply with Standard Components, refer to Standard Component – MRI Scanning Room, Room Data Sheet and Room Layout Sheet.

Ultrasound Ultrasound is a non-invasive procedure using high frequency sound waves for diagnostic purposes This permits the use of ultrasound for a various types of tissue and organs and is particularly useful in obstetrics, digestive system, renal, cardiac and vascular scanning. Ultrasound does not use ionising radiation and does not require radiation shielding. Ultrasound examinations may be done in the Medical Imaging unit, in specialist units or at the patient location, as the equipment is mobile. Ultrasound imaging may involve interventional procedures and room size may need to accommodate additional procedures and access for patients on a bed/ trolley. Ultrasound rooms may require close access to drinking water and a toilet for particular scanning procedures.

Support Areas

Preparation Room The Preparation Room is provided for preparation of contrast media solutions, storage of medications and sterile supplies. The room should be sized to accommodate the quantity of supplies required. The Preparation Room, if conveniently located, may serve several imaging rooms. The Preparation Room shall comply with requirements identified in Standard Components.

Film Processing Areas Film processing if required should be located convenient to the Imaging Rooms and to the quality control area and will normally involve daylight processing equipment .A Darkroom is rarely required, now replaced by digital/ computer processing. The Darkroom, if provided will require special provisions for lighting and ventilation. For digital imaging systems, processing areas are replaced by workrooms for viewing and checking of digital images. The workrooms should be located in close proximity to the imaging rooms and sized appropriately for the numbers of workstations required.

Film Storage For digital imaging applications, there will need to be an area for the PACS (Picture Archiving and Communications System) servers. The PACS server room should be located with ready access to the imaging rooms. A room for filing of patient films may be provided which may include the patient‘s own films and historic films for research purposes. The film store may be located close to the Reception/ administration areas. Secure storage areas for archived film may be remote to the Imaging Unit. Film storage areas must provide a suitable environment to protect films from deterioration and damage.

Staff Areas

Offices and Workstations Offices and workstations may be provided for the Unit Manager, Senior Radiographer, Senior Radiologist and Nurse Manager of the Unit, located in a discreet staff accessible area. The number of offices required will be determined by the clinical service plan, dependent on the role and size of the unit.


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Reporting Rooms Picture Archiving Communications Systems (PACS) reporting areas will include Radiologist workstations for viewing and reporting on procedures using high resolution (LCD) monitors on which images can be manipulated. A minimum of two linked monitors are required, occasionally four screens are provided. In addition to the reporting monitors, a dedicated computer will be required for access to the Patient Information System and a system for dictating reports. Locate reporting areas in a quiet area with ready access to the imaging rooms. Several workstations may be located in one room but will need to be visually and acoustically separated. The reporting area will require:

Ergonomic design of the workstation to accommodate multiple monitors

Adequate ventilation and temperature control to individual spaces to minimise risk of monitor failure

Individual cubicle lighting (dimmable)

Acoustic measures to ensure quality of voice recordings.

Staff Amenities Areas Staff will need access to the following:

Toilets, shower and lockers

Staff room with beverage facilities

Meeting room/s for meetings, education and training.

Functional Relationships

External

The Medical Imaging Unit should be located close to the Main Entrance of the facility and ideally situated at the ground level. Wayfinding to the Medical Imaging Unit should be easily identifiable by staff and visitors. The location of the Medical Imaging Unit is variable. Consideration must be given to its proximity to Accident and Emergency, to the Operating Unit for intra-operative imaging and Radiotherapy/ Oncology for regular patient investigations associated with treatment. The requirement for an Outpatient X-ray Service may also dictate where in the facility it is located. In most instances, a compromise between travelling distance for inpatients (minor role) and convenience for outpatients (major role) will be made.

Internal

Internally, the Medical Imaging Unit will be arranged in functional zones. The entrance to the unit will provide access control with a Reception. Imaging and scanning areas will be located in clusters along with related support facilities such as holding, sub-waiting areas and change rooms for patients. Support areas such as reporting and processing will be located conveniently to the imaging areas and may be shared. Staff areas may be located in a discreet and staff only accessible area. The Medical Imaging Unit should have a clear one-way flow of patients from entry, holding, imaging procedures, to recovery and then exit, for both ambulant and bed/trolley patients.


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Functional Relationship Diagram

Medical Imaging Unit - General The key functional relationships are demonstrated in the diagram below.

Figure 1 Functional Relationship Diagram: Medical Imaging Unit


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Medical Imaging Unit – General, Modular Option

Figure 2 Functional Relationship Diagram: Medical Imaging Unit – Modular Option with integrated Nuclear

Medicine


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The optimum external relationships include:

Visitors access from a main circulation corridor with a relationship to the Main Entrance

Separate entry and access for inpatients, critical care units and Medical Imaging Unit

Access for service units such as Supply and Housekeeping via a service corridor. The optimum internal relationships include the following:

Reception at the entrance providing access control, with Waiting and amenities.

Imaging areas arranged into zones including general X-Ray, Fluoroscopy, CT Scanning, Angiography and MRI

Patient areas including bed bays and Recovery centrally located convenient to Interventional and Scanning Rooms for sharing between imaging modalities

Support areas located centrally to imaging rooms and adjacent to areas of need for staff and patient convenience

Staff areas located in a discreet zone at the Unit perimeter. 3 Design

Construction Standards

Special attention is to be given to the following in the design of a Medical Imaging Unit:

Structural support for equipment including equipment mounted to ceilings

Level floor for equipment positioning and safe patient movement

Provision for cable support trays, ducts or conduits may be made in floors, walls, and ceilings and the impact on room space of large diameter electrical cable trays (to floors or surface mounted on walls)

Equipment ventilation

Procedure timing (clocks)

Task lighting/dimming and room blackout, as required

Ceiling heights shall suit the equipment to be installed, but shall not be less than 3000 mm for ceiling tube mount installations; ceilings may be higher if required

A tiled ceiling may be considered for ease of installation, service, and remodelling.

Standards & Codes

Radiological facilities are to comply with relevant local legislation, regulations and statutory requirements.

Environmental Considerations

Acoustics

Acoustic privacy should be provided in all imaging rooms, interview rooms and particularly in reporting areas Acoustics The design should provide acoustic performance according to the function of spaces being provided. Acoustic separation should be provided between Offices, Meeting Rooms, Interview Rooms and adjacent corridors to reduce transfer of noise between rooms and minimise conversations being audible outside the room. This is particularly relevant for teleconferencing and large meetings. Additional acoustic privacy considerations include:

Waiting areas should not be located close to Offices, Meeting and Interview Room/s

Staff Room/s should not be located close to public and waiting areas.

Natural Light/ Lighting

Natural light is desirable for patient waiting areas, offices and staff recreation areas to provide a sense of wellbeing for patients and staff.


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Provide indirect lighting in all examination rooms for patient comfort and dimmable lighting as required Ceiling mounted shadowless lighting is required in CT and Angiography imaging rooms.

Privacy

Visual patient privacy is an important consideration to be addressed in the design of imaging rooms and waiting spaces. Doors to imaging and screening rooms should be located to avoid patient exposure to circulation areas.

Interior Decor

Interior décor refers to colour, textures, surface finishes, fixtures, fittings, furnishings, artworks and atmosphere. It is desirable that these elements are combined to create a calming, non-threatening environment. Colours should be used in combination with lighting to ensure that they do not mask skin colours in procedure and scanning rooms where clinical observation takes place.

Space Standards and Components

Accessibility

Wheelchair access is required in all patient areas including Waiting, Consult and Imaging rooms. Waiting areas should also include space and power outlets for charging electric mobility equipment along with suitable seating for patients with disabilities or mobility aids. Waiting and sub-waiting areas should include suitable seating and provisions for bariatric patients.

Doors Special consideration should be given to the width and height of doorways to ensure delivery and removal of equipment is not impeded or prevented, and that patient trolley and bed movement is not hampered. Doors through which trolleys and beds must pass should be a minimum of 1200 mm wide.

Ergonomics/ OH&S

Design of clinical spaces including imaging rooms, bed bays and recovery areas must consider Ergonomics and OH&S issues for patient and staff safety and welfare. Refer to Part C – Access, Mobility, OH&S of these Guidelines for further information.

Size of the Unit

The size of the Medical Imaging Unit will be dependent on the level of service and will be determined by the facility’s Service Plan and Operational Policies. Schedules of Accommodation have been provided for typical Medical Imaging Units in a hospital at role delineation Levels 2 (less complex services) to 6 (teaching/ research facilities).

Imaging Room/s The size of imaging rooms will be influenced by the following:

ease of movement in and around the room for patients, staff and equipment; bed and trolley access to all imaging room will be required

the number of staff required in and around the room to operate the equipment and support the patient

the equipment to be installed; design will need to consider the manufacturer’s recommended room sizes, equipment placement and services requirements

potential future upgrading of equipment.


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Safety and Security

Design should consider the following issues:

Access control to the unit which may be provided at Reception

Zones within the unit should be organised to allow patients to access the intended area only and prevent patients and visitors entering unrelated areas

Doors to all offices and at the perimaters of the Unit should be lockable

Rooms used for storing equipment and files and records should be lockable

Meetings and functions scheduled after-hours requiring access by staff and visitors may involve special access arrangements.

Finishes

The Medical Imaging Unit ambience should provide a calm and inviting impression. Finishes should be selected with consideration of the following:

Infection control and cleaning

Acoustic properties of the materials

Durability, replacement of materials

Fire safety of the materials Wall protection should be provided where bed or equipment movement occurs including corridors, bed bays and imaging rooms. Refer also to Part C - Access Mobility, OH&S in these Guidelines for further information on floors and ceilings.

Fixtures, Fittings and Equipment

Equipment, furniture and fittings shall be designed and constructed to be safe, robust and meet the needs of a range of users. Imaging equipment and the necessary services will require installation to the manufacturer’s recommendations and specifications. Refer to Part C - Access Mobility, OH&S of these Guidelines, the Room Layout Sheets (RLS) and Room Data Sheets (RDS) for more information

Building Service Requirements

Communications

The Medical Imaging Unit requires reliable and effective IT / Communications service for efficient operation of the service. The IT design should address:

Booking, appointment and queuing systems

Patient/ clinical information systems and electronic records

Telephones including cordless and mobile phones

Computers, laptops and hand-held computers

Duress alarms and paging master system for staff and emergencies

Wireless and hospital network requirements, high capacity and speed for digital equipment

Video-conferencing and tele-conferencing requirements, including connection to imaging rooms for educational purposed

Communications and Server Room/s

Reporting and recording systems that may include dictation or voice recognition and include printing of reports

Picture Archiving Communications Systems (PACS).


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Emergency/ Nurse Call Patient and Emergency Call facilities shall be provided in all patient areas (e.g. Holding bays, Recovery bays, Preparation rooms, Change Rooms, Toilets and Imaging rooms) in order for patients and staff to request for urgent assistance. The individual call buttons shall alert to an annunciator system. Annunciator panels should be located in strategic points visible from Staff Stations and audible in Staff Rooms and Meeting Rooms.

Heating, Ventilation and Air conditioning (HVAC)

The Medical Imaging Unit should be air-conditioned to provide a comfortable working environment for staff and visitors. Interventional Imaging rooms may require air-conditioning equivalent to operating room conditions, i.e. filtered and positive pressured. Rooms with heat generating equipment may require special air-conditioning. The local or country specific mechanical provision requirements should be consulted.

Medical gases

Medical gases will be included in general and interventional imaging rooms in accordance with standards components or project specific requirements. Refer to the Standard Components, RDS and RLS of these guidelines and to Part E for additional information.

Radiation Shielding

All rooms that are used for undertaking imaging procedures require radiation shielding. A certified physicist or qualified expert will need to assess the plans and specifications for radiation protection as required by the relevant local radiation/nuclear safety authorities. A radiation protection assessment will specify the type, location and amount of radiation protection required for an area according to the final equipment selections, the layout of the space and the relationship between the space and other occupied areas. The radiation protection requirements are to be incorporated into the final specifications and building plans. Radiation requirements should be re-assessed if the intended use of a room changes during the planning stages, equipment is upgraded or surrounding room occupancy is altered. Consideration should be given to the provision of floor and ceiling shielding when rooms immediately above and below are occupied.

Infection Control

Standard precautions apply to the Medical Imaging Unit to prevent cross infection between patients, staff and visitors. Paths of travel for inpatients should be separated from outpatients as far as possible. Hand hygiene is important and it is recommended that in addition to hand basins, medicated hand gel dispensers be located strategically in staff areas and circulation corridors. Consideration should be given to separate clean and dirty workflows in all imaging/ procedure, preparation and clean-up rooms.

Hand Basins Hand basins will be located in each imaging/ procedure room, patient holding, recovery areas as well as clinical support rooms including clean and dirty utilities. In holding and recovery areas the minimum provision is one hand basin per 4 bed or chair bays. Interventional imaging rooms such as Angiography may have an adjoining scrub facility. Hand basins should comply with Standard Components for Bay - Handwashing. Refer to the Standard Components, RDS and RLS of these guidelines for additional information. For further information related to Infection Control refer to Part D – Infection Control in these Guidelines.


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4 Components of the Unit

Standard Components

The Medical Imaging Unit will contain Standard Components to comply with details in the Standard Components described in these Guidelines. Refer to Standard Components Room Data Sheets and Room Layout Sheets.

Non Standard Components

Non Standard rooms are identified in the Schedules of Accommodation as NS and are described below.

Orthopantomography (OPG) Room The OPG imaging unit may be located in a room or bay. The room size will be dependent on the equipment to be installed; circulation space will be required around the imaging unit. Access will be required for patients in wheelchairs. Room requirements will include:

Radiation shielding of the space with access to lead gowns for the patient and staff

Radiation warning light

Patient and emergency call system

A handbasin in close proximity.

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5 Schedule of Accommodation – Medical Imaging Unit - General


The following Schedule of accommodation is provided for RDL 2 to 6 including typical imaging specialties; the inclusion of imaging specialties in health facilities will be dependent on the operational policy of the facility:

ROOM/ SPACE Standard Component RDL 2 RDL 3 RDL 4 RDL 5 RDL 6 Remarks Room Codes Qty x m2 Qty x m2 Qty x m2 Qty x m2 Qty x m2

Entry / Reception Reception/ Clerical RECL-9-I RECL-12-I RECL-15-I 1 x 9 1 x 12 1 x 15 1, 2 & 3 staff.

Waiting WAIT-10-I WAIT-15-I WAIT-20-I 2 x 15 2 x 20 2 x 25 Public. May be divided into gender segregated areas. 1.2sqm per seat, 1.5sqm w/chair.

Bay – Drinking Fountain, 1m2 BWF-1-I 2 x 1 2 x 1 Optional

Bay – Vending Machines BVM-3-I BVM-5-I 1 x 3 1 x 3 Optional

Bay – Wheelchair BWC-I 1 x 4 2 x 4 2 x 4 3 x 4

Consult/ Exam Room CONS 1 x 12 1 x 12 2 x 12 2 x 12 Number dependent on volumes and patient requirements

Office -Shared OFF-2P-I OFF-3P-I OFF-4P-I 1 x 9 1 x 15 1 x 20 1 x 20 Clerical/ bookings; 2, 3 or 4 person shared office.

Office – Workstation OFF-WS-I 1 x 5.5 1 x 5.5 1 x 5.5 Transport Staff. May be located adjacent to trolley parking

Play Area PLAP-10-I PLAP-15-I PLAP-20-I 1 X 10 1 x 10 1 x 10 Adjacent to Family waiting 4-5 places for children.

Toilet – Accessible, 6m2 WCAC-I 2 x 6 2 x 6 2 x 6 May be divided into gender segregated areas.

Toilet – Public, 3m2 WCPU-3-I 2 x 3 2 x 3 2 x 3 May be divided into gender segregated areas.

General X-ray & Fluoroscopy (Screening) General X-Ray GENXR-I 1 x 35 1 x 35 2 x 35 3 x 35 4 x 35

Screening Room (Fluoroscopy) SCRN-I 1 x 36 1 x 36 1 x 36 2 x 36 Includes control area; qty of rooms to suit service plan.

Interventional Screening Room (Fluoroscopy )

SCRN-I (similar) 1 x 45 1 x 45 1 x 45 2 x 45 Optional. For both vascular and Non-vascular procedures

Bay – Handwashing, Type B BHWS-B-I 1 x 1 1 x 1 1 x 1 2 x 1 For patient bed bay areas

Bay - PPE BPPE-I 1 x 1.5 1 x 1.5 1 x 1.5 1 x 1.5 2 x 1.5 For Lead Apron storage

Bay - Linen BLIN-1 1 x 2 1 x 2 1 x 2 1 x 2

Bay – Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 1 x 1.5

Change Cubicle – Patient CHPT-I 2 x 2 3 x 2 4 x 2 4 x 2 May be divided into gender segregated areas.

Change Cubicle – Accessible CHPT-D-I 2 x 4 2 x 4 3 x 4 4 x 4 4 x 4 May be divided into gender segregated areas.

Clean Utility CLUR-8-I CLUR-12-I 1 x 8 1 x 12 1 x 12 May be shared

Dirty Utility DTUR-10-1 1 x 10 1 x 10 1 x 10 1 x 10 Disposal, clean-up, dirty linen storage; may be shared ,

Patient Bay – Holding, 10m2 PBTR-H-10-I 2 x 10 4 x 10 4 x 10 4 x 10 May be divided into gender segregated areas.


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ROOM/ SPACE Standard Component RDL 2 RDL 3 RDL 4 RDL 5 RDL 6 Remarks Room Codes Qty x m2 Qty x m2 Qty x m2 Qty x m2 Qty x m2 Preparation/ Set-up Room (Imaging) PREP-S-I 1 x 9 1 x 9 1 x 9 1 x 9 For contrast media storage and preparation

Property Bay PROP-2-I PROP-6-I similar 2 x 2 2 x 2 2 x 2 Optional; patient lockers. Separate Male/ Female areas.

Waiting WAIT-SUB-I WAIT-10-I 2 x 5 2 x 5 2 x 10 2 x 10 2 x 10 Optional for level-2 & 3. May be divided into gender segregated areas.

Shower – Patient - Accessible SHD-I 2 x 4 2 x 4 2 x 4 2 x 4 Optional May be divided into gender segregated areas.

Toilet – Patient WCPT-I 1 x 4 1 x 4 1 x 4 2 x 4 May be divided into gender segregated areas.

Toilet – Accessible WCAC-I 1 x 6 1 x 6 1 x 6 2 x 6 May be divided into gender segregated areas.

Dental/Oral Radiology

OPG Room N/S 1 x 7 Room area depends on equipment selected

Bay - PPE BPPE-I 1 x 1.5 Lead aprons, adjacent to imaging rooms

Waiting WAIT-SUB-I 1 x 5 May be shared with adjacent imaging areas.

C.T Scanning

C.T Scanning – Procedure Room CTPR-I 1 x 45 2 x 45 2 x 45 Room size is dependent on equipment selected

C.T Scanning – Control Room ANCRT-I similar 1 x 14 1 x 20 1 x 24 May be shared between 2

CT Computer Equipment Room COEQ-I 1 x 8 2 x 8 2 x 8 Room size dependant on equipment selected.

C.T Scanning – Reporting Room XRRR-I similar 1 x 9 1 x 9 1 x 9 One workstation/2 scanning rooms

Waiting WAIT-SUB-I WAIT-10-I 2 x 5 2 x 10 2 x 10 May be divided into gender segregated areas.

Patient Bay – Holding, 10m2 PBTR-H-10-I 2 x 10 2 x 10 2 x 10 1 outside each scanning room. May be divided into gender segregated areas.

Bay – Handwashing, Type B BHWS-B-I 1 x 1 1 x 1 1 x 1 1 per 4 bed bays; Refer to Part D Infection Control

Bay – Linen BLIN-I 1 x 2 1 x 2 1 x 2 May be shared

Bay - PPE BPPE-I 1 x 1.5 1 x 1.5 2 x 1.5 For Lead Apron storage

Bay – Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 May be shared if located in close proximity to another unit

Change Cubicle – Accessible, 4m2 CHPT-D-I 1 x 4 1 x 4 1 x 4 May be divided into gender segregated areas. 1 cubicle per scanning room

Change Cubicle – Patient CHPT-I CHPT-12-I 1 x 2 1 x 2 1 x 2 May be divided into gender segregated areas. 1 cubicle per scanning room


Dirty Utility DTUR-S-I DTUR-12-I 1 x 8 1 x 12 1 x 12 May be shared

Office – Workstation OFF-WS-I 1 x 5.5 1 x 5.5 1 x 5.5 Optional, staff base

Property Bay, 2m2 PROP-2-I 1 x 2 1 x 2 1 x 2 May be shared

Scrub-up/ Gowning, 6m2 SCRB-6-I 1 x 6 1 x 6 2 x 6 May be shared

Toilet –Patient WCPT-I 2 x 4 2 x 4 2 x 4 May be divided into gender segregated areas; may share amenities with adjacent imaging areas.


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Ultrasound & Mammography

Ultrasound ULTR-I 1 x 14 2 x 14 4 x 14 6 x 14 For general and obstetrics

Ultrasound – Paediatric ULTR-I similar 1 x 20 2 x 20 Optional. As required by service plan

Ultrasound - Interventional PROC-20-I similar 1 x 30 2 x 30 For Interventional ultrasonography procedures

Mammography MAMMO-I 1 x 16 2 x 16 3 x 16

Mammography - Interventional MAM-INT-I 1 x 16 2 x 16 3 x 16 For symptomatic and needle biopsy procedures

Patient Bay – Holding, 10m2 PBTR-H-10-I 2 x 10 4 x 10 4 x 10 May be shared. May be divided into gender segregated areas.

Bay – Handwashing, Type B BHWS-B-I 1 x 1 1 x 1 1 x 1 1 x 1 1 per 4 bed bays; Refer to Part D Infection Control

Bay – Linen BLIN-I 1 x 2 1 x 2 1 x 2 1 x 2 May be shared with adjacent area

Bay – Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 1 x 1.5 May be shared if located in close proximity to another trolley

Change Cubicle – Patient CHPT-I CHPT-12-I 1 x 4 1 x 2 2 x 2 4 x 2 Total of 1 per U/S or Mammography room

Change Cubicle – Accessible CHPT-D-I 1 x 4 1 x 4 2 x 4 2 x 4 Total of 1 per U/S or Mammography room

Clean Utility CLUR-8-I 1 x 8 1 x 8 1 x 8 Optional

Dirty Utility DTUR-S-I 1 x 8 1 x 8 1 x 8 Optional

Office – Workstation OFF-WS-I 1 x 5.5 1 x 5.5 1 x 5.5 1 x 5.5 For Sonographers

Processing DPRO-I similar 1 x 6 1 x 6 1 x 10 For Mammography

Property Bay PROP-2-I PROP-6-I similar 2 x 4 2 x 8 2 x 8 For patient lockers. May be divided into gender segregated areas.

Toilet – Patient WCPT-I 1 x 4 3 x 4 4 x 4 For Ultrasound. Within ultrasound room

Toilet – Accessible WCAC-I 2 x 6 1 x 6 1 x 6 2 x 6 Patient. May be divided into gender segregated areas.

Waiting WAIT-SUB-I WAIT-10-I 2 x 5 2 x 5 2 x 10 2 x 10 May be divided into gender segregated areas.

Viewing and Reporting Room XRRR similar 1 x 12 1 x 12 1 x 12 1 12 Adjust size to suit service plan.

Angiography/ Digital Subtraction Angiography (DSA) Angiography Procedure Room ANPR-I similar 1 x 55 2 x 55 3 x 55 Number of rooms to suit service plan.

Angiography Control/ Reporting Room

ANCRT-I 1 x 14 1 x 14 1 x 14 May be shared between rooms

Computer Equipment Room COEQ-I 1 x 8 2 x 8 3 x 8 1 per Angiography room

Anaesthetic Induction Room ANIN-I 1 x 15 1 x 15 1 x 15 Optional

Bay – Linen BLIN-I 1 x 2 1 x 2 1 x 2 1 x 2 May be shared

Bay – PPE (Personal Protective Equipment) BPPE-I 1 x 1.5 1 x 1.5 1 x 1.5 For Lead Apron

Bay – Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 May be shared if located in close proximity to another unit

Change Cubicle – Patient CHPT-I CHPT-12-I 1 x 2 2 x 2 4 x 2 May be divided into gender segregated areas.


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ROOM/ SPACE Standard Component RDL 2 RDL 3 RDL 4 RDL 5 RDL 6 Remarks Room Codes Qty x m2 Qty x m2 Qty x m2 Qty x m2 Qty x m2 Change Cubicle – Accessible CHPT-D-I 2 x 4 4 x 4 4 x 4 Patient. May be divided into gender segregated areas.


Dirty Utility DTUR-S-I DTUR-12-I 1 x 8 1 x 12 1 x 12 May be shared

Patient Bay – Holding, 10m2 PBTR-H-10-I Refer to Holding/Recovery Areas for patient bays.

Preparation/ Set-Up Room (Imaging) PREP-S-I 1 x 9 1 x 9 1 x 9

Property Bay PROP-2-I PROP-6-I similar 2 x 4 2 x 8 2 x 8 For patients; may be divided into gender segregated areas.

Scrub-Up/ Gowning SCRB-6-I 1 x 6 1 x 6 1 x 6 May be shared.

Store – Sterile Stock STSS-12-I STSS-24-I 1 x 12 1 x 18 1 x 24

Toilet – Patient WCPT-I 1 x 4 2 x 4 2 x 4 Within Angiography Suite

Toilet – Accessible WCAC-I 1 x 6 1 x 6 1 x 6 Patient May be divided into gender segregated areas.

Waiting WAIT-SUB-I WAIT-10-I 2 x 5 2 x 10 2 x 10 May be divided into gender segregated areas.

X-Ray Viewing and Reporting XRRR-I 1 x 12 1 x 12 1 x 12 May be combined with Control room

MRI MRI Scanning Room MRI-SC-42-I 2 x 42 Room size dependant on equipment selected

MRI Computer Equipment Room, COEQ-8-I similar 2 x 8 MRI. requirements as per manufacturers specifications

MRI Control/ Reporting Room, 14m2 ANCRT-14-I similar 2 x 14 Shared between 2 MRI rooms

Anaesthetic Induction Room ANIN-I 1 x 15 Optional

Viewing and Reporting Room XRRR-12-I similar 1 x 12 May be combined with Control Room.

Patient Bay - Holding, 10m2 PBTR-H-10-I 2 x 10 May be shared. May be divided into gender segregated areas.

Bay – Handwashing, Type A BHWS-A-I 2 x 1 1 per MRI room, in close proximity to MRI rooms

Bay – Linen BLIN-I 1 x 2 May be shared

Bay – Resuscitation Trolley BRES-I 1 x 1.5 May be shared if located in close proximity to another unit

Change Cubicle – Accessible CHPT- D-I 2 x 4 May be divided into gender segregated areas.

Clean Utility CLUR-8-I CLUR-12-I 1 x 12 May be shared

Dirty Utility DTUR-S-I DTUR-12-I 1 x 12 May be shared

Property Bay PROP-2-I 4 x 2 Patient lockers. May be divided into gender segregated areas.

Store - Dewar Tank N/S 1 x 6 As required, accessible to MRI rooms

Store – Files, 8m2 STFS-8-I 1 x 8 Optional

Toilet – Accessible WCAC-I 2 x 6 Patient. May be divided into gender segregated areas.

Waiting – Sub WAIT-SUB-I 2 x 5 May be divided into gender segregated areas.

Patient Holding/ Recovery Areas


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Patient Bay – Holding, 10m2 PBTR-H-10-I 4 x 10 6 x 10 8 x 10 Holding/ recovery. 2 Bays per interventional imaging room; May be divided into gender segregated areas.

Staff Station SSTN-10-I SSTN-14-I 1 x 10 1 x 10 1 x 14

Bay – Beverage BBEV-OP-I 1 x 4 1 x 4 1 x 4 Optional

Bay – Handwashing, Type B BHWS-B-I 1 x 1 2 x 1 2 x 1

Bay – Linen BLIN-I 1 x 2 1 x 2 2 x 2

Bay – Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 May be shared if located close to another trolley

Consult Room CONS-I 1 x 12 2 x 12 Optional

Clean Utility, 12m2 CLUR-S-I CLUR-10-I CLUR-12-I 1 x 8 1 x 10 1 x 12

Dirty Utility DTUR-S-I DTUR-10-I DTUR-12-I 1 x 8 1 x 10 1 x 12

Disposal Room, 8m2 DISP-8-I DISP-10-I 1 x 8 1 x 8 1 x 10

Store – Equipment, 10m2 STEQ-10-I 1 x 10 1 x 10 2 x 10

Support Areas - Shared

Bay – Mobile Equipment BMEQ-4-I BMEQ-6-I 1 x 4 1 x 6 2 x 6 2 x 6 Depends on facility requirement

Cleaner’s Room, 5m2 CLRM-5-I 1 x 5 1 x 5 2 x 5

Communications Room COMM-12-I COMM-20-I similar 1 x 10 1 x 12 1 x 20 1 x 30 For PACS Server. Size determined by Operational Policy

Dark Room DARK-I 1 x 6 1 x 6 1 x 6 1 x 6 1 x 6 Optional

Digital Processing DPRO-I similar 1 x 16 1 x 24 1 x 30 1 x 40 Digital processing/ printing. As required by service plan

Disposal Room, 8m2 DISP-8-I shared 1 x 8 1 x 8 1 x 8 1 x 8

Store – Current Film STFS-20-I similar 1 x 30 1 x 50 1 x 70 1 x 100 Optional. Depends on facility & digital imaging requirements

Store – Files STFS-8-I STFS-20-I 1 x 8 1 x 8 1 x 12 1 x 16 1 x 20 Films/ CDs/ Discs. Size determined by Operational Policy

Store – General STGN-9-I 1 x 9 1 x 9 1 x 12 1 x 12 1 x 16

Store – Photocopy/ Stationery, 8m2 STPS-8-I 1 x 8 1 x 8 1 x 8 Laser Printing/ Digitiser; may be included in work space for radiographers.

Staff Offices & Reporting Areas Office – Single Person, 12m2 OFF-S12-I 1 x 12 1 x 12 1 x 12 Director

Office – Single Person, 9m2 OFF-S9-I 1 x 9 1 x 9 2 x 9 Radiologists

Office – Single Person, 9m2 OFF-S9-I 1 x 9 1 x 9 2 x 9 Radiographers

Office – Single Person, 9m2 OFF-S9-I 1 x 9 1 x 9 2 x 9 Nurse Manager/ Supervisor

Office – Shared OFF-2P-I OFF-3P-I 1 x 12 1 x 15 1 x 15 PACS Operation/ Management. 2-3 person; see Notes

Office – Shared OFF-2P-I OFF-3P-I OFF-4P-I 1 x 12 1 x 16 1 x 20 2, 3 & 4 person shared areas. May be used as a film study/ library room; as required by operational policy

Office - Workstation OFF-WS-I 2 x 5.5 4 x 5.5 6 x 5.5 General imaging staff


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Office - Workstation OFF-WS-I 2 x 5.5 4 x 5.5 6 x 5.5 Picture Archiving Comms Systems (PACS) Reporting. Qty will depend on service plan

Change – Staff (Male/ Female), 14m2 CHST-14-I 2 x 14 2 x 14 2 x 14 May be divided into gender segregated areas. Includes shower/ toilets/ lockers

Meeting Room MEET-9-I MEET-12-I 1 x 9 1 x 9 1 x 12

Meeting Room – Medium/ Large MEET-L-15-I MEET-L-20-I 1 x 15 1 x 15 2 x 20

Store – Photocopy/ Stationary STPS-8-I STPS-10-I 1 x 8 1 x 8 1 x 10

Staff Room SRM-15-I SRM-20-I 1 x 15 1 x 20 1 x 20 May be divided into gender segregated areas.

Sub Total 77.5 385.0 1290.5 1833.5 2661.5

Circulation % 35 35 35 40 40

Area Total 104.6 519.8 1742.2 2566.9 3726.1 Notes

Areas noted in Schedules of Accommodation take precedence over all other areas noted in the FPU.

Rooms indicated in the schedule reflect the typical arrangement according to the Role Delineation.

Exact requirements for room quantities and sizes will reflect Key Planning Units identified in the Service Plan and the Operational Policies of the Unit.

Room sizes indicated should be viewed as a minimum requirement; variations are acceptable to reflect the needs of individual Unit.

Office areas are to be provided according to the Unit role delineation and number of endorsed full time positions in the unit.

Staff and support rooms may be shared between Functional Planning Units dependent on location and accessibility to each unit and may provide scope to reduce duplication of facilities.


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6 Future Trends Imaging is widely used as an essential adjunct to clinical assessment for diagnosis and staging of human disease, and increasingly in the design of appropriate therapies and then monitoring response to these treatments and has been described as one of the fastest growing healthcare sectors in the developed world. Medical liability considerations also weigh heavily in many decisions by physicians to utilize medical imaging if clinically warranted. It is expected that radiation dosages will continue to drop and utilization of imaging services will become more efficient, with fewer healthcare resources wasted. With the Internet, borders have blurred between the concepts of information and communication systems, making access to data and distribution of information faster and more efficient. Mobile and wearable media will accelerate these trends. New energy sources—magnetic, radiofrequency, sonic, optical and nuclear—combined with fast, dynamic, digital methods of applying and recording them, will continue to add dozens of parameters to the imaging toolkit. Future images will be photo realistic; using all the sources of data combined, enhanced using interactive rendering with additional details, and available remotely at the desktop. Future new technologies (e.g., molecular imaging) could yield rapid utilization changes if these provide the clinical value that has been attributed to traditional advanced imaging during its recent boom 7 Further Reading

Agency for Science, Technology and Research, Clinical Imaging Research Centre, Singapore, Professor David W. Townsend, PhD, FRCR (Hon) Director, lecture: Future Trends in Medical Imaging refer to website: http://infieri-network.eu/sites/default/files/users/user270/DT_INFIERI_Lecture_Final.pdf

American College of Radiology (ACR) Medical Imaging: ‘Is the Growth Boom Over’ Neiman Report Oct 2012 http://www.acr.org/Research/Health-Policy-Institute/Neiman-Report-Index/Brief-01-Is-the-Medical-Imaging-Growth-Boom-Over

Australasian Health Facility Guidelines, Part B Health Facility Briefing and Planning, Medical Imaging - General, Rev 6 2016 refer to website

https://aushfg-prod-com-au.s3.amazonaws.com/HPU_B.0440_6_0.pdf

Department of Health, Queensland Government, Australia Medical Imaging Services; CSCFv3.2 Module Overview. Refe to website:

https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/service-delivery/cscf/modules/default.asp

Department of Veterans Affairs (US) Office of Facilities Management, VA Design Guide Magnetic Resonance Imaging, 2008, refer to website: http://www.cfm.va.gov/til/dGuide/dgmri02.pdf

Government of Dubai, Dubai Health Authority, Health Regulation Department, “Diagnostic Imaging Services Regulation” 2012 https://www.dha.gov.ae/Documents/Regulations/Diagnostic%20Imaging%20Services%20Regulation.pdf

NHS Estates, Department of Health Estates and Facilities Division, HBN 6 Facilities for diagnostic imaging and interventional radiology, HMSO, London, 2001, https://www.gov.uk/government/organisations/department-of-health

RSNA Radiological Society of North America, James H. Thrall, M.D ‘Look Ahead The Future of Medical Imaging’ Aug 2015 http://www.rsna.org/News.aspx?id=17019

The Facilities Guidelines Institute, Guidelines for Design and Construction of Health Care Facilities, 2014 refer to website: https://www.fgiguidelines.org

University of Oxford, Department of Physics, Future Trends in Medical Imaging 2016; refer to website: https://www2.physics.ox.ac.uk/events/2013/07/10/future-trends-in-medical-imaging

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